For all its disturbing moments, the indelible image of The Handmaid’s Tale Season 1 is undoubtedly Ofglen (Alexis Bledel) carefully lifting up her hospital gown, only to realize that by Gilead’s order, her clitoris had been cut off to negate her desire for sex (specifically with a person of the same gender).

“We never actually say female genital mutilation; we never say those words. It’s all indicated and hinted at,” said Bruce Miller, showrunner of The Handmaid’s Tale, on the phone with Inverse.

“We don’t even show the surgery!” said Miller. “What I always try to do is just think of, ‘Okay, how does this happen, realistically. Not the movie version, not the TV version, not the version in my head, but how would this work?’”

Miller wanted the most realistic reaction possible of Bledel, because he knew the true horror didn’t stem from the gore of surgery itself but the effects of it on Ofglen.

Ofglen being carted away by the Eyes.

“There’s no reason to see some of the viscerally brutal stuff,” said Miller.

“It’s not the surgery on Ofglen when she’s asleep that matters, it’s what happens after she wakes up,” he continued. Very aware of the fact that The Handmaid’s Tale is, essentially, a story about how violence is enacted on women, Miller wanted to highlight the emotional and psychological torture rather than the physical (though there is quite a lot of it in Season 1).

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“When you work from there, you can see a place that you can go in and tell something that is incredibly horrifying but not get it to the point where it’s just so uncomfortable to watch,” said Miller. “It’s like when a murderer goes in on TV, and they blow someone’s head off. I feel gross, but no one else in the scene does — it’s much better for a show like this when there’s always someone in the scene who feels like you do.”

The Handmaids take a break by the wall.

The other reason the scene is so horrific stems from the cultural and historical context of FGM itself. Predominately practiced in African countries, as well as Indonesia, Iraqi Kurdistan, and Yemen, UNICEF estimated that roughly 200 million women underwent FGM in 2016. Often used by extreme fundamentalist religious regimes, FGM (erroneously referred to as female circumcision) is practiced worldwide — despite having no medical benefits. It’s done primarily to ensure women — often young girls reaching puberty — cannot experience pleasure during sex in a twisted effort to maintain “purity” and curb sexual appetites. Although it does happen in the United States, FGM is commonly thought of in the Western world as something that only happens to non-white women in developing countries.

At first glance, it might feel appropriative to watch a white women portray a commonly WOC narrative, but Miller said the change was purposeful.

“It’s more shocking because FGM doesn’t happen, isn’t supposed to happen to Rory Gilmore,” said Miller.

“We’re trying to bring in problems of women in societies around the world. I think that bringing things that you read about in other parts of the world home, to America, is kind of one of the reasons people are connecting so much to the story in the age of Trump,” said Miller.

“We’re now in an age where things that seem like they could never happen in America are happening here. Problems that seem to be problems in other cultures, in other countries, with people of different colors, are all of the sudden our problems,” said Miller.

Whether or not the intended audience caught the point being made, Ofglen’s post surgery scene remains the most fucked up scene of Season 1. Feminists and fans of the show will be talking about it for a long time to come.